TL;DR
Medicare pays physician fee schedule services at one of 109 payment localities, each with its own geographic practice cost indices. 53 states and territories have a page here; 16 states are split into several localities and the rest are one statewide locality. The highest geographic adjustment factor in 2026 is Alaska (1.264) and the lowest Arkansas (0.916); the October 2026 ZIP code file maps 42,957 ZIP codes to their locality.
Find the locality for a ZIP code
The finder reads the October 2026 ZIP code to carrier locality file, so it returns the contractor number and locality CMS assigns to the five-digit ZIP code, the 2026 indices and both rural flags. Open the locality's page from the result for its counties, its full ZIP list and example payments.
Localities in numbers
- Payment localities
- 109
- 55 contractor numbers
- States with several localities
- 16
- 37 are one locality
- ZIP codes mapped
- 42,957
- October 2026 ZIP5 file
- Highest GAF
- 1.264
- Alaska
- Lowest GAF
- 0.916
- Arkansas
Localities by state
16 states are split into several localities, usually a metropolitan area and a “rest of state” locality; the other 37 states and territories are one statewide locality, so their state page is the locality page. The District of Columbia locality also takes in the Maryland and Virginia suburbs, and Hawaii shares its locality with Guam.
Highest and lowest geographic adjustment
The geographic adjustment factor (GAF) is a weighted average of a locality's three indices (work 50.9%, practice expense 44.8%, malpractice 4.3%), so it shows in one number how far a typical service is paid above or below the national amount. A GAF of 1.100 means about 10% more than the national fee schedule amount for a service with the average mix of work and practice expense.
| Locality | GAF | |
|---|---|---|
| Highest 1 | Alaska, AK | 1.264 |
| Highest 2 | San Jose-Sunnyvale-Santa Clara (San Benito County), CA | 1.234 |
| Highest 3 | San Jose-Sunnyvale-Santa Clara (Santa Clara County), CA | 1.228 |
| Highest 4 | San Francisco-Oakland-Berkeley (Marin County), CA | 1.209 |
| Highest 5 | San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County), CA | 1.207 |
| Lowest 1 | Arkansas, AR | 0.916 |
| Lowest 2 | Alabama, AL | 0.925 |
| Lowest 3 | Mississippi, MS | 0.926 |
| Lowest 4 | Kansas, KS | 0.936 |
| Lowest 5 | Iowa, IA | 0.936 |
How localities, ZIP codes and contractors fit together
Localities are defined by county in the CMS locality file and identified by a five-digit contractor number and a two-digit locality number, for example 01112-05 for San Francisco. Claims are priced at the locality of the place where the service was furnished, which CMS resolves from the ZIP code on the claim using its quarterly ZIP code file. Each locality page lists the ZIP codes that file assigns to it, including ZIP codes that belong to a neighbouring state, and flags how many are rural or super rural for the physician fee schedule and how many sit on the separate DMEPOS rural list.
The contractor number names the Medicare Administrative Contractor that processes the Part B claims and writes the local coverage determinations for that locality. Physician fee schedule amounts change with the locality, while DMEPOS amounts are set statewide and laboratory tests are paid at one national amount, so each state page also shows the statewide DMEPOS amounts for common equipment. To price any code at any locality, use the fee lookup and RVU calculator; the full GPCI table with anesthesia conversion factors is on the physician fee schedule page.
Where QuickIntell fits with locality pricing
Contract management in QuickRCM keeps payer contracts and fee schedules with their effective dates and compares expected reimbursement against allowed amounts, so a payment priced at the wrong locality or an outdated GPCI year is reviewed before a dispute is opened.
Frequently asked questions
How many Medicare payment localities are there?
109 for 2026, served by 55 contractor numbers. 16 states have more than one locality, California the most with 29; every other state, the District of Columbia locality and the territories are one locality each.
How do I find the Medicare locality for a ZIP code?
Enter the ZIP code in the finder on this page. It reads CMS's October 2026 ZIP code to carrier locality file, which assigns each of 42,957 ZIP codes to a contractor number and locality; a few ZIP codes are split by ZIP+4, in which case the ZIP+4 file decides for addresses near the boundary.
What is the difference between a locality and a MAC jurisdiction?
A locality sets the geographic adjustment of physician fee schedule payments; a Medicare Administrative Contractor jurisdiction decides which contractor processes the claims and writes the local coverage determinations. One contractor serves many localities, and the contractor number in the locality id identifies it.
Do the localities change every year?
CMS can redefine localities through rulemaking and updates the geographic practice cost indices every three years with phase-in steps, so the indices change more often than the locality boundaries.
Related: the Medicare fee schedules hub, the statewide DMEPOS fee schedule and the LCD lookup, which finds the contractor policies for a code.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- CY2026 geographic practice cost indices by Medicare locality (Addendum E)Version CY2026 Addendum E (RVU26D) · effective 2026-01-01 · file GPCI2026.csvSHA-256 7850e2987d12e469…
- Counties included in the 2026 Medicare payment localities (26LOCCO)Version CY2026 (RVU26D) · effective 2026-01-01 · file 26LOCCO.txtSHA-256 c1e3a394d641a207…
- CY2026 anesthesia conversion factors by Medicare localityVersion CY2026 (RVU26D) · effective 2026-01-01 · file ANES2026.csvSHA-256 c4d61aa421069986…
- ZIP code to carrier locality file (ZIP5), October 2026Version ZIP5 October 2026 (file updated 2026-08-13) · effective 2026-10-01 · file ZIP5_OCT2026.txtSHA-256 6892be209ade4324…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- DMEPOS fee schedule DME26-D, October 2026Version DME26-D (October 2026) · effective 2026-10-01 · file DMEPOS_OCT.csvSHA-256 a2824d58aadf4004…
- DMEPOS rural ZIP code file, quarter 4 2026Version Q4 2026 · effective 2026-10-01 · file DME Rural Zip Code Quarter 4 2026.csvSHA-256 226616fbcbc4ace5…
Disclaimer
Operational reference compiled from the CMS physician fee schedule locality files. Amounts are Medicare fee schedule amounts before the deductible, coinsurance, sequestration and claim-level reductions; Medicare Advantage and commercial contracts set their own rates. Not legal, coding or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.